PURPOSE: The C-14 urea breath test (C-14 UBT) is the most specific noninvasive method to detect Helicobacter (H) pylori infection. We investigated if the C-14 UBT can reflect the presence and degree of H. pylori detected by gastroduodenoscopic biopsies (GBx). MATERIALS AND METHODS: One hundred fifty patients (M:F=83:67, age 48.6+/-11.2 yrs) underwent C-14 UBT, rapid urease test (CLO test) and GBx on the same day. For the C-14 UBT, a single breath sample was collected at 10 minutes after ingestion of C-14 urea (137 KBq) capsule and counting was done in a liquid scintillation counter for 1 minute, and the results were classified as positive ( 200 dpm), intermediate (50~199 dpm) or negative (<50 dpm). The results of CLO tests were classified as positive or negative according to color change. The results of GBx on giemsa stain were graded 0 (normal) to 4 (diffuse) according to the distribution of H. pylori by the Wyatt method. We compared C-14 UBT results with GBx grade as a gold standard. RESULTS: In the assessment of the presence of H. pylori infection, the C-14 UBT global performance yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 92.5%, 88.4%, 97.1%, 88.4% and 91.3%, respectively. However, the CLO test had sensitivity, specificity, PPV, NPV and accuracy of 83.2%, 81.4%, 91.8%, 81.4% and 82.7%, respectively. The quantitative values of the C-14 UBT were 45+/-27 dpm in grade 0, 707+/-584 dpm in grade 1, 1558+/-584 dpm in grade 2, 1851+/-604 dpm in grade 3, and 2719+/-892 dpm in grade 4. A significant correlation (r=0.848, p<0.01) was found between C-14 UBT and the grade of distribution of H. pylori infection on GBx with giemsa stain. CONCLUSION: We conclude that the C-14 UBT is a highly accurate, simple and noninvasive method for the diagnosis of ongoing H. pylori infection and reflects the degree of bacterial distribution.
Azure Stains ; Biopsy ; Breath Tests* ; Diagnosis ; Eating ; Helicobacter pylori* ; Helicobacter* ; Humans ; Scintillation Counting ; Sensitivity and Specificity ; Urea* ; Urease

The thirty eight newborn infants with periventricular leukomalacia who were admitted to the neonatal intensive care unit of Gil General Hospital from March 1, 1988 to June 30, 1991, were investigated for ultrasonographic findings, risk factors and neurological outcome. The results were as follows: 1) There were 38 cases of PVL including 21 echogenic flarings and 17 cystic PVL's. 2) Mean birth weight was 2,250 gm and mean gestational age was 35 week. 3) Mean detection timing was 4th day in echogenic flarings and 18th day in cystic PVL's. 4) PVL's were located in the parietal region in 1 case and fronto-parieto-occipital in 3 cases. 5) Mean cyst size was 6 mm. 6) Multiple logistic regression analysis for the risk factors of PVL showed that low birth weight, apnea and seizure were the most significant contributing factors (p<0.05). 7) In the follow-up study of cystic PVL's, 7 cases showed improvement, 7 cases developed into multicystic encephalomalacia and 3 cases developed into atrophy. 8) Neurodevelopmental outcome of cystic PVL's showed nomal; 6.2%, minor neurodevelopmental defect; 43.8%, major neurodevelopmental defect; 31.2% and death; 18.8%. 9) Neurosonographic predictability for neurodevelopemental sequelae by cystic PVL's showed sensitivity; 63.6%%, specificity; 98.0%, positive predictive value; 92.8% and accuracy; 88.2%. 10) Major neurodevelopmental defect was more frequent, cyst size being larger and location being more extensive (p<0.05).
Apnea ; Atrophy ; Birth Weight ; Encephalomalacia ; Follow-Up Studies ; Gestational Age ; Hospitals, General ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Logistic Models ; Rabeprazole ; Risk Factors* ; Seizures ; Sensitivity and Specificity

BACKGROUND: Percutaneous mitral commissurotomy(PMC) has been known as an effective therapeutic modality for moderate to severe mitral stenosis. However, long-term results and factors influencing late outcome after PMC remain to be elucidated. MATERIALS AND METHODS: Three hundred and forty-six patients received PMC at Seoul National University Hospital between August, 1988 and March, 1996. We evaluated long-term results of these patients and assessed demographic, clinical, echocardiographic and hemodynamic variables in order to identify predictors of immediate and late outcomes. RESULTS: PMC was completed without major complication or technical failure in 339(98%) out of 346 cases. A good immediate result was obtained in 67% of cases. Multivariate study identified echocardiographic score(P=0.004) and left atrial volume(P=0.009) as independent predictors of immediate outcome. The estimated 3-year and 5-year event-free survival rates were 95.8+/-2.5% and 90.6+/-4.3%, respectively. According to multivariate analysis, the independent predictors of late outcome were pre-PMC left atrial volume(P=0.03), post-PMC mitral valve area(P=0.01), and severity of mitral regurgitation after PMC(P=0.03). CONCLUSION: Percutaneous mitral commissurotomy as a treatment for patients with mitral stenosis is safe, and achives good long-term results. Pre-procedural echocardiographic score, left atrial volume, post-procedural mitral valve area, and severity of mitral regurgitation affect the immediate and late outcomes after PMC.
Disease-Free Survival ; Echocardiography ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Multivariate Analysis ; Seoul

BACKGROUND AND OBJECTIVES: The endothelium plays an important role in maintaining vascular tone and function. Essential hypertension may be associated with alterations in endothelial function. The effects of antihypertensive agents on endothelial function have not been fully evaluated in human hypertension and data on the forearm circulation of humans are controversial. The aim of this study was 1) to evaluate the endothelial function in hypertensive patients 2) to investigate whether vitamin C administration has benefit on the endothelial function and 3) to determine whether treatment with ACE inhibitor improve endothelial dysfunction in hypertensive patients. MATERIALS AND METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 8 hypertensive patients and 8 healthy volunteers. The patients in the hypertension group were treated with enalapril, then examined again. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. The measurement of forearm volume change was repeated for 7 times each stage. RESULTS: Forearm blood flow response to acetylcholine was significantly enhanced with inra-arterial infusion of vitamin C in hypertensive group before antihypertensive treatment(302+/-58 % --< 446+/-43 %). Co-infusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine(Vit C(+; 446+/-43 % --< Vit C +L-NMMA; 229+/-23 %). After antihypertensive treatment with enalapril for 2 months in hypertensive group, endothelium-dependent vasorelaxation (vasodilatory response to acetylcholine) was significantly improved in treated group compared to before enalapril treatment(302+/-58 % --< 643+/-78 %). CONCLUSIONS: Even though the mechanisms leading to depressed endothelial function in essential hypertension remains to be elucidated, our study shows that vitamin C and ACE inhibitor result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Antihypertensive Agents ; Ascorbic Acid* ; Brachial Artery ; Enalapril ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Hypertension* ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Vasodilation ; Vitamins*

BACKGROUND: Since reperfusion early after acute myocardial infarction has been demonstrated to reduce the infarct size and mortality, many drugs and interventions to reduce the reperfusion injury have been tried with limited success. Adenosine, a potent coronary vasodilator, has been reported to counteract a few mechanisms implicated with reperfusion injury, however, its effects and exact mechanisms to reduce the reperfusion injury have not been clearly elucidated. METHODS AND RESULTS: Effects of adenosine upon infarct size reduction and upon postulated mechanisms involved in the reperfusion injury such as no reflow phenomenon and neutrophil infiltration were evaluated in anesthetized open chest dog model where acute myocardial infarction was induced by 90 minute left anterior descending coronary artery occlusion followed by 240 minute reperfusion. Adenosine(3.75 mg/min) was administered intravenously for total 90 minutes from 30 minutes before reperfusion. Compared to control group(n=6), infarct area/risk area ratio was significantly lower in adenosine group(n=6)(34+12% vs. 22+/-11, p=0.04), although risk area/total left ventricular area ratio were similar in both groups. Myocardial blood flows(MBF), measured by radiolabelled microspheres, of the infarcted regions during coronary occlusion were similar in both groups, however, both subepicardial MBF(0.63+/-0.15ml/min/g vs. 0.95+/-0.31, p=0.02) and subendocardial MBF(0.45+/-0.08 ml/min/g vs. 0.69+/-0.27, p=0.02) were higher in daenosine group. Neutrophil infiltration, semiquantitatively measured under light microscope, were less severe in daenosine group,compared to control group. CONCLUSION: Intravenous adenosine administered before coronary reperfusion appears to reduce infarct size by limiting reperfusion injury through improving no reflow phenomenon and preventing neutrophil infiltration to the ischemic myocardium during reperfusion.
Adenosine* ; Animals ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Microspheres ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Myocardium ; Neutrophil Infiltration ; No-Reflow Phenomenon ; Reperfusion Injury* ; Reperfusion* ; Thorax*

BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia especially in the elderly. Despite the beneficial effect of anticoagulation to prevent disastrous complication of throm-boembolism, anticoagulation is not widely used in patients with atrial fibrillation. The purpose of this study was to identify the prevalence and clinical characteristics of atrial fibrillation and investigate the current status of anticoagulation in the elderly. METHODS: Through electrocardiographic analysis of 6,138 elderly (> or =65yr) patients from tan. to Dec. 1997, 386 patients with atrial fibrillation was found. Among the 386 patients, 274 patients with available medical records were enrolled for review of clinical findings (associated diseases, risk factor of throm-boembolism, medications) retrospectively. RESULTS: Mean age of population with atrial fibrillation was 72+/-6yr. The prevalence of atrial fibrillation was 6.2% and increased with age (65-69yr: 5.4%, 70-74yr: 6.4%, 75-79yr: 7.5%, 80yr-:9.0%). Atrial fibrillation with valvular hear disease was 27% of patients. Common associated diseases with nonvalvular atrial fibrillation were hypertension (48%), diabetes mellitus (18%), coronary artery disease (25%), congestive heart failure (21%), history of stroke or transient ischemic attack (27%). Anti-coagulation was used in 59% of valvular atrial fibrillation patients without contraindications (prosthetic valve: 100%, native valve: 42%), 24% of nonval-vular atrila fibrillation. Antiplatelet therapy with aspirin was 15%, 30% respectively, Aspirin was used in only 20% of atrial fibrillation patients with contraindication of anticoagulation. CONCLUSION: Atrial fibrillation is prevalent in the elderly. Anticoagulation and antiplatelet therapy in atrial fibrillation appears to be less than optimal.
Aged* ; Arrhythmias, Cardiac ; Aspirin ; Atrial Fibrillation* ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography ; Heart Failure ; Humans ; Hypertension ; Ischemic Attack, Transient ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Triacetoneamine-N-Oxyl

PURPOSE: The aim of this study was to determine whether crossed cerebellar hyperperfusion (CCH) was helpful in discriminating mesial from lateral temporal lobe epilepsy (TLE) and what other factors were related in the development of CCH on ictal brain SPECT. MATERALS AND METHODS: We conducted retrospective analysis in 59 patients with TLE (M:41, F:18; 27.4+/-7.8 years old; mesial TLE: 51, lateral TLE: 8), which was confirmed by invasive EEG and surgical outcome (Engel class I , II). All the patients underwent ictal Tc-99m HMPAO brain SPECT and their injection time from ictal EEG onset on video EEG monitoring ranged from 11 sec to 75 sec (32.6+/-19.5 sec) in 39 patients. Multiple factors including age, TLE subtype (mesial TLE or lateral TLE), propagation pattern (hyperperfusion localized to temporal lobes, spread to adjacent lobes or contralateral hemisphere) and injection time were evaluated for their relationship with CCH using multiple logistic regression analysis RESULTS: CCH was observed in 18 among 59 patients. CCH developed in 29% (15/51) of mesial TLE patients and 38% (3/8) of lateral TLE patients. CCH was associated with propagation pattern; no CCH (0/13) in patients with hyperperfusion localized to temporal lobe, 30% (7/23) in patients with propagation to adjacent lobes, 48% (11/23) to contralateral hemisphere. Multiple logistic regression analysis revealed that propagation pattern (p=0.01) and age (p=0.02) were related to the development of CCH. CONCLUSION: Crossed cerebellar hyperperfusio ictal brain SPECT did not help differentiate mesial from lateral temporal lobe epilepsy. Crossed cerebellar hyperperfusion was associated with propagation pattern of temporal lobe epilepsy and age.
Brain* ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Logistic Models ; Retrospective Studies ; Technetium Tc 99m Exametazime* ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Atherosclerosis is the most important disease that may cause ischemic syndrome in many organs including heart. It is supposed that apoptosis of vascular smooth muscle cells(VSMCs) is closely related to the progression and rupture of atheromatous plaque. Recent studies have documented evidence for elevated level of nitric oxide(NO) within advanced human atheroma and evidence of regression of atheroma by NO. So this study is designed to evaluate whether exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs and which proapoptotic gene(s) is involved in this type of apoptosis. METHODS: Rat VSMCs were cultured and used for experiment at passage 5 through 7. For NO donor, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine(SNAP) of 0.5, 1, 2, 4mM were exposed to subconfluent VSMCs. The cells were harvested at 6, 12, 24, 48, 72hours after exposure of NO donors. Apoptosis was to be identified by 4, 6-diamidino-2-phenylindole dihydrochloride(DAPI) staining of nuclei and in-situ nick end labeling(TUNEL). The amount of fragmented DNA was analyzed semiquantitatively by diphenylamine(DPA) assay. Immunocytochemical(ICC) staining and western bolt analyses were designed to detect apoptosisrelated gene products, such as Bax-a, Fas and Bcl-2. RESULTS: 1) Decreased mitotic activity was shown after 12 hours exposure of exogenous NO donors, and condensation and margination of chromatin was identified agter 24 hours exposure, by DAPI staining. 2) Percent DNA fragmentation assessed by DPA method was 0,2,9,48,45% at 0,6,12,24,48 hours after exposure of 2mM of NO donors respectively. 3) The expression of Bax-a and Bcl-2 proteins was demonstrated in apoptotic cells by ICC staining. 4) The expression of Bax-a protein in cells under 24 hours exposure of NO donors was elevated by more than 18% of control level on densitometric analysis of western blot. The level of Bcl-2 was suppressed by 26% of control. So, Bax-a/Bcl-2 ratio in cells under exposure of NO donors was elevated to 2.0 from 1.2 of control level. CONCLUSIONS: Exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs, and it is considered that bax-a and bcl-2 genes are involved in this type of apoptosis.
Animals ; Apoptosis* ; Atherosclerosis ; Blotting, Western ; Chromatin ; DNA ; DNA Fragmentation ; Genes, bcl-2 ; Heart ; Humans ; Muscle, Smooth, Vascular* ; Nitric Oxide ; Nitroprusside ; Plaque, Atherosclerotic ; Rats* ; Rupture ; Tissue Donors

Isometric tension recording was performed in the transverse strips of porcine coronary arteries and rabbit aorta to observe the effects of the endothelium and endothelium-derived relaxing factor(EDRF) on vasomotor tone and to test the hypothesis that alcohol may have the deleterious effect on endothelium-dependent vasorelaxation. Tension-development by vasoconstrictor was markedly attenuated in the endothelium-intact strips compared to the endothelium denuded strips. Administration of hemoglobin(10-5M) to inhibit the action of EDRF increased tension selectively in the endothelium-infarct strips, which is suggestive of basal EDRF secretion. Nitro L-arginine(10-5M). an analogue of L-arginine(10-4M) partially reversed the inhibitory effect of nitro L-arginine. Ethyl alchol inhibited bradykinin-induced endothelium-dependent vasorelaxation of porcine coronary artery in dose dependent manner. These data suggest that the protective effect of vascular endothelium to the action of vasoconstirctor can be explained by exercise of basal EDRF release and damaged endothelium would be a great risk of induction of vasospasm. Also we believe that there is a relationship of competive inhibition between L-arginine. a precursor of EDRF, and its analogues on the action of EDRF and alcohol intake would be hazardous to the patients with coronary artey disease because its inhibitory action on endothelium-dependent vasorelaxation may evoke myocardial ischemia.
Aorta ; Arginine ; Coronary Vasospasm ; Coronary Vessels* ; Endothelium* ; Endothelium, Vascular ; Ethanol* ; Humans ; Myocardial Ischemia ; Spasm* ; Vasodilation

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires